Measles outbreaks have infected nearly 130 people in several U.S. communities this year, and metro Phoenix is at a high risk of an outbreak, too, some health experts say.

Several factors are putting schoolchildren at risk — including the state's vaccine policy, politics in the Arizona Legislature, a well-organized community of people opposed to vaccine regulation, and a lack of consistent, easily accessible science-based information about vaccines for parents.

Metropolitan Phoenix is the single U.S. location most susceptible to a large, sustained measles outbreak, said Dr. Bob England, who was director of the Maricopa County Department of Public Health for 12 years between 2006 and 2018.

In an interview with The Arizona Republic, England said that Maricopa County is at particular risk because of its large population — 4.3 million people.

Declining vaccination rates in county public schools, particularly in charter schools, mean an outbreak could be both large and expensive, he said.

"We don't have the lowest immunization rates or the highest exemption rates in the country. But we're so big that if you get an outbreak here — let's say a case of measles drops into one of those schools with a really low (vaccination) rate — and you get several new cases of measles right away," England said.

"We're big enough and our population moves around enough that there's just a really high chance, I think, that you'd get enough cases from those initial ones to make for a really widespread, ongoing outbreak."

All it will take right now is a measles case in the "right place at the right time" and Arizona will have a measles outbreak — possibly as bad as the one happening right now in Washington state, concurred Will Humble, Arizona Public Health Association executive director.

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A measles outbreak in the Pacific Northwest has sicked 38 people so far and has forced some people to change their daily routine. One mother says she's not taking her 11-month-old son out in public until he gets his measles vaccine at age one. (Jan. 30)
AP

A growing number of parents worldwide, including in Arizona, are choosing not to vaccinate their children. The World Health Organization recently cited "vaccine hesitancy" as one of the top-10 threats to global health for 2019.

Measles, a highly contagious virus, is fatal in one or two out of every 1,000 cases. Though it was at one time eliminated from the U.S., it is now making a resurgence.

Last year, 372 measles cases across the U.S. were reported to the U.S. Centers for Disease Control and Prevention in 17 outbreaks, including three outbreaks in New York state, New York City, and New Jersey. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities

Here's why Arizona is at risk for outbreaks of vaccine-preventable diseases.

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Too many Arizona schools are below 'herd immunity' for measles

When not enough kids in a class are immunized for measles, that means "herd immunity" is lost and the group is more susceptible to an outbreak. It's particularly worrisome for kids with compromised immune systems and babies too young to be immunized.

"Immunization affects the entire population — that is the nature of how it works. Herd immunity makes it work. It's not really an individual health choice," England said.

Based on data from the 2017-2018 academic year, more than 5,000 kindergarten students in Arizona would be at risk for measles in the event of an outbreak, the Arizona Department of Health Services says.

Vaccine-preventable diseases in Arizona more than quadrupled between 2008 and 2013, representing an average increase of 242 cases per year, according to a 2018 study by University of Arizona researchers published in the journal PLOS One.

Specifically, cases of pertussis, also known as whooping cough, increased sixfold during that time period, the researchers found.

Public-health officials consider herd immunity for measles to be a vaccination rate of 95 percent or more. ForMaricopa County kindergartners, the overall rate of kindergarten students fully immunized with the measles, mumps and rubella vaccine was 93.1 percent for the last academic year, state data shows.

"You have pockets dragging that average down, where there are frighteningly low immunization rates," England said.

Arizona allows non-medical 'personal belief' exemptions from vaccines

Arizona is one of 17 states that allow parents to exempt their children from vaccines because of their personal or philosophical beliefs.

Personal-belief exemptions over the last decade have increased in two-thirds of the states — including Arizona — that allow them, a June 2018 study by researchers at Baylor University published in PLOS Medicine found.

Phoenix was named as one of the top cities where children are not vaccinated in June 2018. The study was published in the PLOS Medicine journal.(Photo: Getty Images)

The California Legislature in 2015 eliminated all non-medical vaccine exemptions following a measles outbreak at Disneyland that affected seven Arizona residents. The rate of vaccinated schoolchildren in California has since increased.

"I honestly believe we as a community would be safer if we did away with personal-belief exemptions," England said. "But I doubt seriously that politically that is going to work here (in Arizona), unless we have a really bad outbreak."

The Republican-controlled Arizona Legislature this session did not move bills that could have resulted in better vaccine coverage.

An Arizona bill introduced by state Rep. Alma Hernandez, a Tucson Democrat, would eliminate personal-belief exemptions altogether. But House Bill 2162 has not yet been assigned to a committee, and the deadline to do so was Friday.

Another Arizona bill that would require schools to post vaccination-coverage levels on their websites is likely to die this session, too.

"This at least gives parents like myself information that could impact where they send their child to school," said Kaye Lawson, a Phoenix parent whose 12-year-old son spent nine years with a fragile immune system due to cancer treatment.

"The average treatment time for kids who have cancer is two to three years. During that time, kids have compromised immune systems," she said. "This bill would give parents more information and choice."

In addition to requiring Arizona schools to post immunization rates on their websites, Butler's bill would require schools to post whether the school has a registered nurse assigned to the school, and the clinical credentials of the people providing health services on the school campus.

Butler told The Republic that Rep. Nancy Barto, R-Phoenix, refused to hold a hearing on the bill. Barto, the chairwoman of the House Human Services Committee, did not respond to the Republic's phone calls and emails this week.

Barto sponsored three other separate bills related to vaccinations for schoolchildren that the Arizona Public Health Association and other public health officials opposed, arguing they will decrease immunization coverage and jeopardize herd immunity.

During the meeting, Barto disputed state data showing that vaccine exemptions have gone up in Arizona. She claimed the rates "are static." She also allowed two vaccine critics to make an hour-long presentation prior to hearing testimony on the bills.

'Vaccine hesitant' parents are getting confusing information

Any parent trying to do their own immunization research on the internet is going to see conflicting information and it's confusing, England said.

A 1998 study in The Lancet reported a link between autism and vaccines, and while the study has since been discredited, some vaccine critics continue to believe there is a link.

Vaccine critics who attended hearings in the Arizona Legislature this week argued that media reports about herd immunity are propaganda, that vaccines injure more kids than people realize, and that physicians are vaccinating children even though they are at risk of having adverse, physical reactions.

Those criticisms "lead you down a certain path" and are presented in a biased way that doesn't allow for looking at all the data and information, said Dr. Negin Blattman, a molecular virologist and assistant chief of infectious diseases at the U.S. Department of Veterans Affairs in Phoenix who attended one of the hearings.

"Vaccines prevent disease. We know this. It's true," Blattman said. "If you want to find out if this is really real and about complications of vaccines, ask our veterans who serve in countries where there are still outbreaks of measles and polio and see how they are protected, their reaction to vaccines."

Just this week, the wife of the White House communications chief has tweeted about bringing back childhood diseases like measles because they "keep you healthy and fight cancer," the Washington Postreported.

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Darla Shine, the wife of White House communications director Bill Shine tweeted about the benefits of measles and made anti-vaccination claims. Veuer's Justin Kircher has more.
Buzz60

"With more and more inaccurate stuff floating out there on social media, it is really easy as a good, responsible parent to get confused," England said. "If you Google 'immunization safety,' you get a whole bunch of anti-immunization sites popping up.

"It's not that we have so many parents who are adamantly opposed to immunization, it's just that we have a lot of parents who, I think, get confused by all the competing claims out there."

Arizona had a pilot program last academic year that offered parents seeking vaccine exemptions for their children a science-based online curriculum about vaccines and the diseases they prevent.

But after a backlash from parents, including several who said they don't vaccinate their children, the state canceled the program. The Arizona Department of Health Services is working on bringing the education program back for the 2019-2020 academic year.

A well-organized community mistrusts the science on vaccines

Groups critical of vaccines track vaccine bills in state legislatures, including Arizona, and organize letter-writing campaigns to lawmakers. Their arguments often focus on parental rights, individual rights and freedom.

More than 100 parents and individuals wrote emails to the Governor's Regulatory Review Council last summer opposing a science-based vaccine education course for parents seeking vaccine exemptions for their children.

Many of those writers sent the same letter, saying they would be opposed to taking any additional step to get a vaccine exemption. A course created with material from public-health organizations is "one-sided," one writer argued.

"In an era when science is less and less relied upon or valued, and is looked at as just another opinion, then it becomes really hard to counter all that misinformation," England said. "To an extent the more we try to (counter the misinformation), the worse we make it."

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The Center for Disease Control says there have been more than 100 cases of the measles since the beginning of 2019, with more than half concentrated in Washington state. But health officials say the outbreak is boosting vaccination and awareness (Feb. 14)
AP

Major public-health organizations support vaccinations, citing scientific evidence that they are far safer than the potentially fatal diseases they prevent.

Yet for some people, doubts linger.

"For the hard-core anti-vaccine folks, it's not a scientific question. It's a belief," England said. "But really, this is the one health choice in which we are all in this together. And we either have to make a decision as a society to protect ourselves using this tool, or not."

England said choosing not to vaccinate your child is like not following the speed limit, with the rationale that you can drive as fast as you want, and it's no one else's business but yours.

"We don't let people do that because it puts other people at risk," he said.